Shoulder & arm injuriesThe shoulder consists of more than one point of contact between two bones, and can be considered a girdle of interacting bones, muscles and joints.
The main joint consists of the ball shaped head of the humerus whose point of contact is a shallow socket on the scapula. This joint allows the arm and hand to perform a wide range of movements.
The shoulder blade (scapula) increases the range of movement of the arm by sliding over the rib cage under muscular control.
The collar bone (clavicle) attaches to the sternum and the acromion (a thin oblong prominence at the top of the spine of the scapula). This provides support, and turns freely as the rest of the shoulder moves.
The muscles of the shoulder are not only to produce movement, but also provide protection and support, for what is quite a vulnerable part of the body. The muscles can be divided into two groups:
Ø The superficial muscles (those close to the surface)
Ø The deeper musculotendinous rotator cuff
The rotator cuff muscles and their associated tendons meet on the head of the humerus and help prevent dislocation.
Rotator cuff injuries Both overuse and trauma can affect the tendons of the rotator cuff muscles. This could be repetitive weight training exercises or a “wrenching” action that combines abduction and rotation.
Overuse injuries require complete rest and avoidance of the activity that has caused the problem. return to normal sports activities should not be too rapid, and if symptoms do not settle medical attention should be sought.
Frozen shoulder
This condition usually occurs in middle aged people, and limits movement in the shoulder. The restriction on movement is often severe and in most cases is accompanied by pain and can disturb sleep.
There is often a history of minor trauma.
If frozen shoulder is left untreated, pain will probably subside over a period of several months, but restriction of movement may remain.
Pain killing medication and rest can help in the initial stages; but the main aim is to improve the final range of movement; therefore exercises that gradually increase shoulder movement are important to rehabilitation.
Shoulder dislocation
This can occur after a fall on an outstretched hand which will often produce an anterior dislocation, i.e. the head of the humerus is displaced forward. In the case of a direct blow to the front of the shoulder, the head of the humerus may be displaced backwards.
The dislocation needs to be “put back” as soon as possible at a hospital casualty department, to both reduce the intense pain and ensure minimal amount of damage from prolonged stretching of the tissues.
The arm will probably be held by bandage for a couple of weeks to prevent further dislocation. After this the sportsperson will require a rehabilitation programme of strength, function and movement exercises to regain mobility.
Fracture of the clavicle
This injury can occur following a fall on a outstretched hand or from a direct blow to the shoulder.
These injuries are fairly common and are usually accompanied by a creaking sensation at the time of the injury. There is immediate pain and rapid swelling, and deformity is common.
If the bone is not displaced the shoulder should be immobilised for 6 weeks, and it may be necessary to suspend all activity for up to 3 months.
As other vessels and structures lie close to the clavicle, it is important that an X-ray and medical attention is sought as soon as possible to ensure there is no other damage.
Biceps tendinitis
The biceps muscle of the upper arm has a long tendon which crosses the front of the shoulder joint and can become inflamed, usually as the result of vigorous throwing actions.
Pain is felt at the front of the shoulder, particularly during such movements as reaching back to put the arm in a shirt sleeve, and needs rest followed by exercises to regain flexibility and strength.
If the tendon is ruptured producing immediate pain, swelling and weakness, a doctor should be consulted.
Neck injuries
Severe spinal injuries unfortunately occur in sport, and are often made worst by poor and incorrect initial treatment and management of the injury. There is evidence of injured sport participants who at the time of injury occuring were able to move their limbs yet became paraplegic or quadriplegic. There are also examples of people presenting with unstable neck fractures to casualty departments a couple of weeks after the accident occurs.
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